Wednesday, July 19, 2006

RAMIFICATONS III – HOME CARE




For most of us, in western countries at least, the assumption is that if we become ill, we can go to a hospital and receive appropriate care. In much of the world, this simply isn’t an option. In Africa, many people are born, live, and die without ever seeing a doctor, or the inside of a clinic, and those that are lucky enough to receive medical care, receive a far different standard of care than we are used to.


Come a pandemic, our medical system will likely collapse, despite the best efforts of dedicated and concerned health care workers. Health care will be rationed we have been told, although no specifics have been given as to how this will be done.


The backbone of our medical response to a pandemic is the policy that nearly all flu victims will be cared for in their home, by their families. Given that there are only 1 million hospital beds in the country, and the likelihood that up to 30 million people could be stricken at roughly the same time during a pandemic, there is little choice in this matter. No matter how you slice it, you can’t hospitalize 30 million patients when you only have 1 million beds.


Of course, the situation is worse than that. Of those 1 million hospital beds, more than 90% are already occupied. We don’t have a million beds available for flu patients. We don’t even have 100,000 beds. And the number of spare ventilators, almost always required to treat and stabilize severe influenza, probably runs between ten and twenty thousand nationwide.


So one can understand why health authorities are saying that people need to plan to stay home if they have the flu, and that families will need to take care of them. Only, they say, will the most critical patients receive hospital care.


Sounds reasonable. And given our limited resources, it probably is. I can see no way to treat 30 million Americans with pandemic flu in a hospital setting. It simply is impossible.


But the implication is that most pandemic flu patients will have a mild form of the disease, and that only a small portion of flu victims will really need hospitalization. And right now, all evidence is to the contrary.


To date, more than half of all avian flu victims have died, and most of them received hospital care, including antiviral meds, antibiotics, IV’s, and ventilator support.


We’ve seen absolutely no proof that `mild cases’ occur. The hope . . . the prayer . . . is that the virus will exchange lethality for transmissibility when it mutates.


While publicly ignored by health officials, mostly because it is an insolvable problem and too horrible to contemplate, it remains a distinct possibility that the virus will retain its high CFR (Case Fatality Rate). And if that happens, the death rate could well skyrocket to 80% or beyond.


It’s a miserable thought. But it has to be considered.


There are things you can do for a flu victim at home. Lifesaving things, in fact. But for many, if the CFR remains high, it will do little good. We need to be prepared for this possibility. And, sadly, we need to learn to accept it if it happens.


Acceptance is not, however, the same thing as giving up.


Oncologists accept the reality that despite their best efforts, many of their patients will die. This does not deter them from treating cancer victims. And a high CFR, and the lack of medical resources, should not stop us from trying to treat, and save, flu victims.


Historically, pandemics rarely infect more than 1/3rd of the population. It will be up to the 2/3rds who remain healthy to care for the sick. To do that, you need to have, in your home, the proper materials. Oral re-hydration solutions, fever reducers, and possibly even anti-virals and antibiotics. We need to be thinking about sick room supplies, infection control, and sanitation needs.


Dr. Gannet Woodson has written an excellent guide for treating pandemic flu. It can be downloaded from:


http://www.fluwikie.com/uploads/Consequences/NewGuideOct7b.pdf


This is a layman’s guide to treating avian flu. Download it. Read it now. And get in the basic supplies you will need.


If a pandemic does occur, you will learn what it means when they government says you will be on your own.


Don't get caught unprepared.